The French health care system is based on universal coverage by one of several health care insurance plans. The SNIIRAM database merges anonymous information of reimbursed claims from all these ...plans, linked to the national hospital‐discharge summaries database system (PMSI) and the national death registry. It now covers 98.8% of the French population, over 66 million persons, from birth (or immigration) to death (or emigration), making it possibly the world's largest continuous homogeneous claims database. The database includes demographic data; health care encounters such as physician or paramedical visits, medicines, medical devices, and lab tests (without results); chronic medical conditions (ICD10 codes); hospitalisations with ICD10 codes for primary, linked and associated diagnoses, date and duration, procedures, diagnostic‐related groups, and cost coding; date but currently not cause of death. The power of the database is correlatively great, and its representativeness is near perfect, since it essentially includes the whole country's population. The main difficulty in using the database, beyond its sheer size and complexity, is the administrative process necessary to access it. Recent legislative advances are making this easier.
EGB (Echantillon Généraliste de Bénéficiaires) is the 1/97th random permanent representative sample of SNIIRAM, with planned 20‐year longitudinal data (10 years at this time). Access time is 1 to 3 months, but its power is less (780 000 subjects). This is enough to study common issues with older drugs but may be limited for new products or rare events.
Health insurance is a guarantee in the form of health protection so that participants obtain health care benefits and protection in meeting basic health needs that are given to everyone who has paid ...contributions or whose contributions are paid by the government. The purpose of this study is to describe the implementation of the BPJS (Social Security Administering Agency) Health claim system for inpatients at Imelda Workers' Hospital in Indonesia. This type of research is qualitative with a case study approach. The method used is observation and direct interviews to the field. The subjects used in this study were all pending and disputed medical record claim files for inpatients and in March 2022 as many as 94 claim files. The informants used in this study were 3 BPJS Health claims officers. Based on the results of the study, the implementation of inpatient BPJS Health claims is in accordance with regulations and SOPs at Imelda Indonesian Workers Hospital in Medan, the obstacles in the claiming process are facilities and networks that often have problems. The claim officer will scan the inpatient file and insert it into the hard disk and send it to BPJS Kesehatan. The hospitalization files that were claimed and submitted in March 2022 were 420 files, of which 326 files were received (78%) and 94 files were rejected (pending claims) (22%). There were also 27 disputed claim files in March 2022 (29%), after the submission of pending claims was made by Imelda Indonesian Workers Hospital in Medan.
Patent claims and patent scope Marco, Alan C.; Sarnoff, Joshua D.; deGrazia, Charles A.W.
Research policy,
November 2019, 2019-11-00, Volume:
48, Issue:
9
Journal Article
Peer reviewed
Patent scope is one of the important aspects in the debates over “patent quality.” The purported decrease in patent quality over the last decade or two has supposedly led to granting patents of ...increased breadth, decreased clarity, and questionable validity (in part due to over-breadth). Such patents allegedly diminish the incentives for innovation due to increased transaction costs in the market for technology, more frequent disputes and litigation, trolling behavior, and breakdowns in bargaining. This paper focuses on the patent examination process at the PTO, highlighting the relationship between patent scope and the patent examination process. We develop and validate two measurements of patent scope: independent claim length and independent claim count. These metrics—in contrast to other measurements of patent scope—can be calculated before and after examination and enable us to provide the first large-scale analysis of trends in patent scope changes during the examination process. Our results show that applications with narrower scope are associated with a higher probability of grant and a shorter and less intense examination period in comparison to applications with broader scope. Further, we find that the examination process itself tends to narrow the scope of patents relative to the scope at filing, and that the changes are more significant when the duration and intensity of examination is increased. We explain our metrics and make our data available in a public use dataset, which we hope will encourage more research in the evaluation of patent scope, patent examination, and patent quality more broadly.
This Special Issue includes original research and reviews of the literature focusing on food labels, which are a tool to promote public health that, at the same time, may represent a marketing tool ...and may influence consumers’ perception of food quality.
•Slovenian consumers in general are moderately doubtful of products bearing NHCs.•The trust in the formal authorities and social system are important for accepting foods with NHC/images.•Consumers ...who did not trust the social system also did not accept foods with NHC/images.•There are four groups of consumers regarding the reasons for their (non)acceptance of NHCs;
To understand consumers’ acceptance and preference in relation to Nutrition and Health Claims (NHCs) on food products and the reasons for their (non)acceptance in an Eastern European country with a weak tradition in NHC, and an enormous increase in the number of foods with NHCs in recent years, this study aimed to fill a research gap by applying a multi-methodological approach combining a survey and conjoint analysis (n = 204) and a focus group (n = 45). The survey demonstrated that Slovenian consumers in general are moderately doubtful of NHCs. Conjoint analysis showed that when Slovenians choose their breakfast cereals, NHCs are more important than whether visual images are present. Visual images convince only the youngest consumers. The study revealed the importance of social perception and trust in the social system for accepting foods with NHCs/images. Consumers who did not trust the political and economic system also did not accept foods with NHCs/images.
Machine learning is increasingly used to predict healthcare outcomes, including cost, utilization, and quality.
We provide a high-level overview of machine learning for healthcare outcomes ...researchers and decision makers.
We introduce key concepts for understanding the application of machine learning methods to healthcare outcomes research. We first describe current standards to rigorously learn an estimator, which is an algorithm developed through machine learning to predict a particular outcome. We include steps for data preparation, estimator family selection, parameter learning, regularization, and evaluation. We then compare 3 of the most common machine learning methods: (1) decision tree methods that can be useful for identifying how different subpopulations experience different risks for an outcome; (2) deep learning methods that can identify complex nonlinear patterns or interactions between variables predictive of an outcome; and (3) ensemble methods that can improve predictive performance by combining multiple machine learning methods.
We demonstrate the application of common machine methods to a simulated insurance claims dataset. We specifically include statistical code in R and Python for the development and evaluation of estimators for predicting which patients are at heightened risk for hospitalization from ambulatory care-sensitive conditions.
Outcomes researchers should be aware of key standards for rigorously evaluating an estimator developed through machine learning approaches. Although multiple methods use machine learning concepts, different approaches are best suited for different research problems.
Background Health care claims data may provide a cost-efficient approach for studying chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants We compared ...characteristics and outcomes for individuals with CKD defined using laboratory measurements versus claims data from 6,982 REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study participants who had Medicare fee-for-service coverage. Predictors Presence of CKD as defined by both the REGARDS Study (CKDREGARDS ) and Medicare data (CKDMedicare ), presence of CKDREGARDS but not CKDMedicare , and presence of CKDMedicare but not CKDREGARDS , and absence of both CKDREGARDS and CKDMedicare. Outcomes Mortality and incident end-stage renal disease (ESRD). Measurements The research study definition of CKD (CKDREGARDS ) included estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or albumin-creatinine ratio > 30 mg/g at the REGARDS Study visit. CKD in Medicare (CKDMedicare ) was identified during the 2 years before each participant’s REGARDS visit using a claims-based algorithm. Results Overall, 32% of participants had CKDREGARDS and 6% had CKDMedicare . Sensitivity, specificity, and positive and negative predictive values of CKDMedicare for identifying CKDREGARDS were 15.5% (95% CI, 14.0%-17.1%), 97.7% (95% CI, 97.2%-98.1%), 75.6% (95% CI, 71.4%-79.5%), and 71.5% (95% CI, 70.4%-72.6%), respectively. Mortality and ESRD incidence rates, expressed per 1,000 person-years, were higher for participants with versus without CKDMedicare (mortality: 72.5 95% CI, 61.3-83.7 vs 33.3 95% CI, 31.5-35.2; ESRD: 16.4 95% CI, 11.2-21.6 vs 1.3 95% CI, 0.9-1.6) and with versus without CKDREGARDS (mortality: 59.9 95% CI, 55.4-64.4 vs 25.5 95% CI, 23.6-27.4; ESRD: 6.8 95% CI, 5.4-8.3 vs 0.1 95% CI, 0.0-0.3). Among participants with CKDREGARDS , those with abdominal obesity, diabetes, anemia, lower eGFR, more outpatient visits, hospitalization, and a nephrologist visit in the 2 years before their REGARDS visit were more likely to have CKDMedicare. Limitations CKDREGARDS relied on eGFR and albuminuria assessed at a single visit. Conclusions CKD, whether defined in claims or through research study measurements, was associated with increased mortality and ESRD. However, individuals with CKD identified in claims may represent a select high-risk population.
Machine learning techniques make it feasible to calculate claims reserves on individual claims data. This paper illustrates how these techniques can be used by providing an explicit example in ...individual claims reserving.
PDF
